Standing Committee D

[Mr. Bill O'Brien in the Chair]

Water Bill [Lords]

Clause 61 - Fluoridation of water supplies

Melanie Johnson: I beg to move amendment No. 319, in
clause 61, page 76, line 28, leave out from 'until' to end of line 30 and insert 
 'an indemnity with respect to the arrangements has been given by virtue of section 90 below— 
 (a) to the water undertaker; and 
 (b) to any licensed water supplier which is entitled to one.'.

Bill O'Brien: With this it will be convenient to discuss the following:
 Amendment No. 220, in 
clause 61, page 80, leave out lines 6 to 9 and insert— 
 '(1) The Secretary of State shall indemnify every water undertaker which enters into arrangements under section 87(1) above against all liabilities that any such undertaker may incur in complying with such arrangements, other than liabilities arising from the undertaker's own fault or negligence. 
 (1A) Subject to subsection (1) above, each indemnity shall be on such terms as (with the consent of the Treasury) may be agreed between the Secretary of State and the undertaker.'.
 Government amendment No. 343. 
 Amendment No. 111, in 
clause 61, page 80, leave out lines 10 to 15.
 Amendment No. 221, in 
clause 61, page 80, line 10, at beginning insert 
 'Subject to subsection (1) above'.
 Amendment No. 222, in 
clause 61, page 80, leave out lines 12 and 13.
 Government amendment No. 344.

Melanie Johnson: It is a pleasure to rise in the knowledge that discussions have been going on for some time without me. The only other time that that happens is when the Chief Secretary to the Treasury occasionally appears in Committee for the Finance Bill, but I am afraid that I cannot claim such status.
 The amendments relate to the indemnities granted by the Secretary of State to water suppliers that agree to fluoridate a water supply under arrangements with a strategic health authority and water undertaker. They are of great significance to the water industry, and as a general policy, we would not want a water supplier that agrees to fluoridate to incur any additional liabilities compared with one that does not have a fluoridation scheme. 
 Amendment No. 319 provides for licensed water suppliers to be given an indemnity if they agree to fluoridate a water supply under arrangements made 
 between a strategic health authority and water undertaker. Although we do not envisage strategic health authorities making arrangements with licensed water suppliers to fluoridate, we would not want to discourage licensed water suppliers from supplying water as well as water undertakers. 
 We want to ensure that there would not be any disincentive to a licensed water supplier bidding to supply water in a fluoridated area. We originally thought that the indemnity would be covered on the access agreement made between the undertaker and licensed supplier. We now consider that it would be more satisfactory if the licensed supplier had an indemnity in its own right. 
 Amendments Nos. 343 and 344 are consequential to amendment No. 319. Amendment No. 343 provides for both a situation in which the licensee is distributing water fluoridated by a water undertaker and one in which the licensee is fluoridating water under an agreement with the undertaker. 
 I have some sympathy with amendment No. 220 and consequential amendments Nos. 221 and 222, but I cannot commit at this stage to indemnifying suppliers against all liabilities. It is our general intention to give wide indemnities, but I want to reserve our position until we start work on the regulations so that we can tease out in greater detail how, for example, negligence on the part of the water undertaker could be excluded. Regulations could also contain model indemnities agreed by the Secretary of State and the Treasury, which the strategic health authorities and water undertakers could insert into their arrangements without needing Whitehall to go over the detail on every occasion. The flexibility would be prevented by new subsection (1)(a) proposed in the amendment.

Norman Baker: Will the Minister give way?

Melanie Johnson: No, I think that I will finish my remarks, and then the hon. Gentleman may make his own.
 On amendment No. 111, the Water Industry Act 1991 currently provides the power for the Secretary of State to grant indemnities, but with little detail on what they may cover. The Department has produced some model indemnities, but they do not have any statutory force. We want to remedy that, but it would not be appropriate to include the detail in the Bill. 
 In light of those assurances, I commend amendments Nos. 319, 343 and 344 to the Committee, and I hope that Opposition Members will not press their amendments, on the understanding that the issues will be addressed in the regulations, which will be debated in the House under the affirmative resolution procedure.

Bill Wiggin: What a change to be in this rather tropical atmosphere rather than the freezing conditions in which we were considering what became known as the Ice Bill. The Minister has already made a generous concession this morning by recognising the value of amendment No. 220, and I am extremely grateful to her. If we can continue with this co-operation we may have a better Bill.
 The Minister talked about different policies for different water companies. Can she confirm that the differences in the policies will not mean that people in some areas are properly indemnified and in others they are not, or that if consumers have evidence that fluoride in the water is doing them damage they will be able to sue in some areas but not in others? 
 We want proper protection for consumers in all areas. I am therefore surprised that the Government have chosen to go down this route of different policies. Obviously, different insurance companies will provide different types of cover. That may not be exactly what she meant and I would be grateful if she could come back to that. She also talked about the phrase ''all liabilities''. Obviously, when taken on its own it covers everything, but that is not the intention of amendment No. 220; it is intended to refer to all liabilities connected to the addition of fluoride to the water.

Melanie Johnson: The hon. Gentleman will appreciate that his amendment uses that phrase: hence my remarks.

Bill Wiggin: That leads nicely on to the Minister telling us what liabilities she proposes to cover and what will be excluded. What sums of money will be put aside or paid by the Government to provide that sort of cover? Anyone who drives a car knows that they have to be insured for pretty much everything that they do when something goes wrong even though that can be well out of their control. Yet at the same time it seems that the Government are being a bit weaselly here about what they mean by all liabilities, although I am sure that that is not what they intend. We need to know exactly what the Government mean, what they will do, how much it will cost and what is not included in the insurance liabilities.
 This is just the tip of the iceberg. We cannot consider whether the Government should be fluoridating in the first place unless we know exactly what that will protect us against. After all, this is a balance. ''Proportionality'' is one of my favourite words, thanks to the Minister for the Environment, who has remained silent this morning, perhaps tragically. We are balancing the risk of tooth decay in young children against a risk that may be faced by all people, whatever their age. 
 I do not believe that science is sufficiently clear about whether fluoridation is a good thing. If I am to be persuaded that it is, I must know that the safeguards are in place. Unfortunately the Minister's statement is far from clear about that. She has quite a lot of work to do to convince us not only that the proper scientific work has been done, but that the proper protection is in place. I look forward to hearing how she does that.

Simon Thomas: I want to follow up on the hon. Gentleman's comments. What was missing from the Minister's introduction was any explanation of why we need to indemnify water companies against the addition of fluorides into our water supply. Could it be because the product in question is registered as a part II poison under the
 Poisons Act 1972? Could it be because the Government's York report asked for further serious research to be undertaken into IQ and congenital defects that may be associated with the addition of fluoride to our water supply?
 How will silicofluorides be brought into our food stream? That, in effect, is what will happen if we take them into our water supply; we will ingest them along with our food and drink. I do not know precisely how silicofluorides will be brought into our food stream when they are still registered as a part II poison, along with arsenic and paraquat. We need to indemnify water companies against putting arsenic and paraquat in our water supply, and so we need to indemnify them against putting fluoride in our water supply. Why do we need to indemnify water companies? Could it be anything to do with the fact that the Medicines Control Agency has refused to class silicofluorides as a medicinal product? We are talking about putting something into our food and drink supply that may do us harm. 
 The Minister is the Under-Secretary of State for Health, after all, so it would be nice to hear a little bit about health in this context. Could she tell us precisely what further high-quality research her Department has commissioned to inform the debates of the Committee and the House on the addition of fluorides to our water supply? What research, asked for in the York report, has been commissioned on the possible negative effects on IQ and on congenital defects, particularly Down's syndrome? 
 In the Minister's letter of 16 October—which, I take it, she sent to all members of the Committee—she says that further high-quality research, specifically asked for, has now been downgraded to a low priority. That is a scandal; it is scandalous that, when the Government commission an independent report into a possibly dangerous additive to our water supply, and that report says that we need high-quality research on the possible effect of fluorides on congenital brain defects, we do not get it.

Richard Burden: Does it say anywhere in the York report that the water supply should not be fluoridated?

Simon Thomas: The hon. Gentleman is correct to suggest that the York report does not say that. Nor does it say that the water supply should be fluoridated; that is the point. Earl Baldwin of Bewdley, who was on the advisory panel for the York review, wrote, in response to the Government's acceptance of the report, that there was not
''any discrepancy in praising fluoridation as a health measure while admitting that too little was known about its effects.''
 That is my response to the hon. Gentleman—we do not know; the science has not been fully done. The Government accepted what the York report said as carte blanche to put fluoride in our water supply, although the case has not been proved at all.

Bill Wiggin: Earl Baldwin of Bewdley has been extremely vociferous about what is in the York report. One of the biggest problems is the misinterpretation of the science. It is fair to say that the York report is
 probably the only science that has been done on the subject—

Brian Iddon: It is a review of the science.

Bill Wiggin: Perhaps I exaggerated, and if so, I apologise. However, the York report seems to be the definitive document on the science that has been done. Earl Baldwin has been vociferous against the addition of fluoride, and it is only fair to take his point of view extremely seriously, because he was involved in the report. The hon. Member for Ceredigion (Mr. Thomas) has covered that point, but I would be grateful if he would say a little more about it.

Simon Thomas: I thank the hon. Gentleman, and indeed I will say a little more about it. In response to the way that the York report had been received, Professor Trevor Sheldon, the chairman of the review advisory panel, said:
''The review team was surprised that in spite of the large number of studies carried out over several decades there is a dearth of reliable evidence with which to inform policy. Until high quality studies are undertaken providing more definite evidence, there will continue to be legitimate scientific controversy over the likely effects and costs of water fluoridation.''
 The hon. Member for Bolton, South-East (Dr. Iddon) said that the York report was a review of the science, and I accept that, but the Minister's letter to us of 16 October says that when the York report reviewed the science, it found a lack of reasonably peer-reviewed current evidence. That is why Professor Sheldon said that 
''in spite of the large number of studies carried out over several decades there is a dearth of reliable evidence with which to inform policy''.
 We need to go beyond the views of both the anti-fluoride campaigners and the Government, and consider the York report carefully.

Brian Iddon: I take a great interest in Down's syndrome. Has the hon. Gentleman any evidence to suggest that in areas that have been fluoridated for 40 years, such as Birmingham and the west midlands, there are more incidences of Down's syndrome than anywhere else in the country? Does he not think that if that were the case, it would have come to the fore in the last 40 years?

Simon Thomas: I would have expected the York review to say that there was no link or danger whatever. The hon. Gentleman knows that it said that further high-quality research into that is needed. I am not a scientist—my science stopped at advanced O-level—and I confess that I must be guided by science. When the chairman of a review panel says that there is legitimate scientific controversy, I, as a legislator, want to know the answer to that controversy.
 I make a personal decision to brush my teeth with fluoride twice a day; I have no problem using fluoride myself, as that is my own decision. The question is what we are indemnifying water companies against in this regard. We are not indemnifying Boots against putting fluoride in toothpaste or the local pharmacy against selling fluoridated toothpaste, so why are we indemnifying water companies? Is it because the 
 Government recognise that questions could be asked? Is it because certain factors could emerge if countrywide or large-scale fluoridation were introduced? Is it because things are emerging in Switzerland and America, and questions about the efficacy of fluoridation are being asked? 
 These amendments relate only to the indemnity. Questions should be asked about whether fluoridating water achieves what the Government think it achieves, or at least whether it is better than simply having a good oral care regime and educational programme. No doubt we shall have the opportunity to say something about that. 
 My fundamental question is: if the York review says so clearly that we need further high-quality research, why are Members of Parliament being asked to legislate without that research? I cannot support any measure to introduce fluoride into our water supply unless and until we see that research, and unless and until there is no scientific controversy over the addition of fluoride to the water supply.

Norman Baker: It is perhaps inevitable that we progress to the wider issue when discussing these amendments. I have considerable sympathy with the points made by the hon. Gentleman. However, I shall try, without prejudice, to limit my remarks to the amendments before us. That involves the question, which has been asked by two hon. Members this morning, of what these indemnities are for. Clearly, we need to have that spelt out. It also raises the fairly common-sense point that, if there is no risk whatever, why are water companies so insistent on having the indemnities in the first place? That seems to make no sense.
 That said, if there were a risk, or even if there were no risk, water companies should not be in the firing line. It is right that they should not be exposed to any potential action in future. They are in the middle, between the public, who may, theoretically, wish to complain, and the Government, who wish to push this measure through. In a sense, the companies are an unwilling agent for this proposal, so they should not be exposed. The basis of the amendments leads to a number of questions that have been asked, and I need not repeat them.

Brian Iddon: Is not the greatest risk that fanatics against fluoridation, particularly supporters of the National Pure Water Association, will litigate, and that the water companies do not want to stand the cost of that litigation?

Norman Baker: It is clear that water companies should not have to defend themselves, be distracted or have a financial penalty imposed for something that is not their doing. To that extent, I support the Bill's indemnity proposals, but it still prompts the question as to why they are there in the first place. If legislation clearly concludes that they are required if fluoride is to be added to water, that would be a defence in law for the water companies, which I suggest would be watertight in any case. The legal action likely to be taken by fanatics, as the hon. Member for Bolton, South-East put it—I would not use that word—against the water companies would not be very
 successful if companies had a statutory duty to add fluoride in the first place.

Richard Burden: The hon. Gentleman has, I am sure, gone through the arguments about this. A statutory requirement to fluoridate water could not be included for the very reason that one does not need to put fluoride in water where it occurs naturally.

Norman Baker: That is the situation now. We have managed without indemnities or requirements on water companies, but the Government now seek to move the goalposts and introduce a measure that they feel requires indemnities to be introduced. The hon. Gentleman shakes his head, but why, then, is the clause before us? It is because a new situation is arising. I am unhappy with the whole process, but I will not go on about the science now, because that would probably be better dealt with under a later group of amendments.
 I do not want to get off on the wrong foot with the Minister, but she would not allow me to intervene first thing this morning. In every other sitting, the other Minister allowed interventions at every opportunity by every member of the Committee. I would not wish her to have begun as she has. 
Miss Johnson rose—

Norman Baker: I do not intend to give way. The Minister can take her turn, as I had to take mine. Perhaps she will be kind enough to address in her concluding remarks the intervention that I wanted to make: will she clarify the position in respect of private water suppliers? I think that they supply about 2 per cent. of the water in this country, but they can be significant in local areas, and there may be some pressure for fluoride to be added in those areas. I am thinking, for example, of a place in my constituency where there is a facility owned by the Glynde estate, which supplies an entire village. Such an arrangement is not unusual. How will the Bill affect private water suppliers?

Nick Palmer: On a point of order, Mr. O'Brien. I want to refer to the remarks of the hon. Member for Leominster (Mr. Wiggin). It does seem quite tropical here. Have we not gone from one extreme to the other?

Bill O'Brien: That is not a point of order.

Melanie Johnson: I assure the hon. Member for Lewes (Norman Baker) that I normally take many interventions. It was just that I had virtually one sentence left to say at that point and there seemed to be no sense in allowing an intervention, given that I knew that he would have a lot of remarks to make. I had perhaps forgotten that the Liberal Democrats are not the main Opposition, so I assumed that he would follow me. [Hon. Members: ''You can do better than that.''] Opposition Members are on a touchy day; we will have to be careful with their egos.
 The point of the proposal is to ensure that no water company is in a different position from any other. However, as hon. Members will appreciate, this is 
 about enabling local communities to decide for themselves on fluoridation; it is not about this place taking the decision. As a result, some areas may be fluoridated—some already are—and others will not be. For that reason, companies may find themselves in a different position.

David Drew: It would be helpful if we knew what legal advice the Government received. There is an expectation on the part of water companies that they will face litigation. It would be helpful to know in particular what discussions there have been between the lawyers of the water companies and the Government lawyers.

Melanie Johnson: I have to try to help my hon. Friend, but the Government's legal advice is seldom supplied. In this case, I am not aware of any legal advice other than that relating to what ought to go in the Bill—lawyers are obviously involved in that connection.

Andrew Lansley: But surely legal advice must have been taken as to the compatibility of this provision with the European convention on human rights in order for the Minister for the Environment to make the statement that he did.

Melanie Johnson: The hon. Gentleman is being a little technical. Of course, that matter has been dealt with, otherwise Ministers would not have signed off the statement that all Ministers must sign off. The hon. Member for Salisbury (Mr. Key) may gesticulate and wave the Bill about, but it is true that every Minister must sign such a statement. However, that is not the point being raised by my hon. Friend the Member for Stroud (Mr. Drew). He is asking whether we have sought specific legal advice on the issue of litigation. All I can say is that I am not aware of any such advice being sought.
 The water companies are now competing commercially with one another, and we think that that is to the consumer's advantage. We must ensure that there is no difference in respect of fluoridation, so we must ensure that no fluoridating undertaker is worse off. That is the Government's position, and that is what the amendments are designed to achieve. It is not the private insurance companies that will bear the risk but the Exchequer. The Government therefore carry any risk that there is, and I shall come to what it is in a moment.

Diana Organ: On the point of water companies being concerned about possible litigation that may go against them, has the Minister any record from the past 40 years of cases of litigation relating to suppliers of water to Birmingham and the east midlands and fluoride in the water.

Melanie Johnson: I am not aware of any such cases. My hon. Friend brings me on to another important point. There are many countries in the world, as well as the UK, where fluoridation has been happening for a long time. That includes huge sections of the population and a large chunk of the USA, a country where litigation is often to the fore. In the United States, 64 per cent. of the population receives fluoridated water, and I am not aware that that has been a issue. Los Angeles took the decision in 1999 to add fluoride
 to the water, so that covers another large chunk of the US population. In some parts of the UK, fluoride has been in our water for many decades. About 6 million UK residents drink water with fluoride in it.

Simon Thomas: The Minister has just said there have been no cases of litigation in areas that have fluoridated water supply. She has also said that she is not aware of any legal advice from the water companies regarding indemnity. If there is no indemnity at present, why on earth include it in the Bill?

Melanie Johnson: Section 90 of the Water Industry Act 1991 already provides for the Secretary of State to indemnify water companies against liabilities connected with fluoridation. In terms of the exercise of indemnities, we are talking about one Birmingham resident in the past five years who would not pay his water bill.
 As I know from my former ministerial job, the water companies are now in a highly competitive industry. They are nervous about anything that makes any difference between one company and another. Therefore, the Government must ensure that the playing field is level. Some hon. Members seem to be attaching too much excitement to this issue.

George Osborne: Has the cost of this indemnity to the taxpayer been estimated? Is legal action anticipated? If there were any action, how much would that cost the taxpayer?

Melanie Johnson: I am not aware of any such costings, or of any anxiety about the matter.
 The hon. Member for Ceredigion discussed Down's syndrome and fluoridation. The York study found that there was no association between them—but it was critical of the quality of the evidence. The Medical Research Council also did not find any plausible medical explanation for that association, so it regarded research in this area as a low priority. 
 Nothing that anyone takes in can be guaranteed to be 100 per cent. safe, but when consideration is given to the record of fluoride in water throughout the world—including the UK—it must be concluded that there is no evidence that it causes a lot of the problems that people are raising. If the hon. Member for Ceredigion was really concerned about this matter, he would not have fluoride in his toothpaste.

Simon Thomas: That is a matter of individual choice, which is what I want to preserve for everyone in this country.
 It is my understanding that the York survey team found no evidence of an association between bone factors, infant mortality, cancer and water fluoridation. However, on possible negative outcomes—such as congenital and IQ defects—it stated that further high-quality research is required. The Minister said that, in response to that, the Medical Research Council stated that research on this matter was a low priority. However, she released a press statement on 4 September, in which she stated that she had asked the chief medical officer and the chief dental officer to advise on the implications of the 
 York report for Government policy on fluoridation. What has been the content of that advice?

Melanie Johnson: We have had a 48-year experience of fluoridation in parts of the country. The York report was commissioned. The MRC reported in September 2002 on the work that we commissioned. The study into bio-availability is now complete, but it is still subject to peer review. When we have the advice of the chief medical officer and the chief dental officer, we will commission further research. We are not complacent about any of these issues.
 On the hon. Gentleman's point about individual liberties, I understand and respect the fact that some people hold those views, but trying to cast aspersions by suggesting links between certain conditions or diseases and fluoride in the water is not about individual freedoms but about whether the facts bear out such assertions or anxieties. Although I sympathise with some of his attitudes, I do not share this one: we must keep the science separate from the fact that some people would prefer individuals to make their own decisions on this matter.

Bill Wiggin: The Minister cited medical people as sources. Does she consider fluoride to be a medicine?

Melanie Johnson: No, I do not. I assume that the hon. Gentleman is picking up on my reference to the chief medical officer. He is involved in this because it has been regarded as a public health issue. I am proud that it is regarded in that way, because it is about the dental health of our population and some of the many inequalities that exist. That is a reason for considering the matter of fluoride in water.

Simon Thomas: I understand from the Minister's remarks that a further report that she requested in September 2002 from the chief medical officer and the chief dental officer on the implications of the York review for Government policy on fluoridation has not yet been received. As I explained earlier, it is of extreme concern to me, as someone who tries to follow the best scientific advice available—on, say, cloning or any other issue—that we are debating something in the Committee and in the House about which we do not have advice from the chief medical officer and the chief dental officer.
 If fluoride is not a medicine, what is it? If it is added to the water supply of a large number of people, what will be the response of the chief medical officer and the chief dental officer to that?

Melanie Johnson: The hon. Gentleman will know, from the many letters that I am sure I have written to him and to many other Committee members, that a medicine is defined, and that fluoride is not a medicine as it is defined; therefore it is inappropriate to call fluoride a medicine. That is the simple fact.
 We are discussing the Bill today; we are not taking any decisions.

Bill Wiggin: On a point of order, Mr. O'Brien. The Minister has said that medicine is defined. I have the definition that it is any
''substance or combination of substances presented for treating or preventing disease in human beings or animals''.
 It would be helpful if the Chair could decide whether that is a definition of medicine.

Bill O'Brien: That responsibility is not for the Chair but for the experts. However, I am sure that the Minister has taken note of the point.

Melanie Johnson: Thank you, Mr. O'Brien. We expect to get the final study very soon. We will also, I think, want to commission further research. However, I point out to the hon. Gentleman that the next stage of the Bill—assuming, as one never should, that it makes the expected progress—will be regulation-making. After that there will be discussion in strategic health authority areas, and decisions on implementation will be made at local level. By that time, a great deal more information will be available.

Bill Wiggin: I note that the Minister decided, without reading the newspapers, to respond to the hon. Member for Lewes with a little crawling. I see that the hon. Gentleman wishes to speak.

Norman Baker: It is very courteous of the hon. Gentleman to give way. The Minister may have responded on that point, but she has not answered the point that I was trying to make about private water suppliers.

Bill Wiggin: The hon. Gentleman is absolutely right. The Minister has not answered any of the questions that we have raised this morning. It is surprising, because the Government have been rather unfair on the Minister for the Environment, who has done his best to answer our questions. Providing a substitute this morning has proved very disappointing. How can the Government possibly allow legislation to go ahead if they have not done their legal work or the costings? That is extraordinary.

Andrew Lansley: Does my hon. Friend agree that the Minister has not answered the points that he made about the nature of the indemnity that the Government are proposing? In resisting amendment No. 220 while saying that she was sympathetic to it, the Minister fixed upon the word ''all'' in front of ''liabilities'' and then said that the Government want flexibility on issues such as negligence. However, amendment No. 220 makes it clear that the indemnity offered would not be in relation to liabilities
''arising from the undertaker's own fault or negligence.''
 She has still presented no argument against that amendment.

Bill Wiggin: I entirely agree with my hon. Friend. He is absolutely right. This is not the easiest part of the Bill to go through, and the way in which it is presented is extremely complicated, but that is no excuse for a Minister turning up without having done any homework. The questions being asked are entirely reasonable and entirely proper, and have not been ruled out of order. She has even failed to tell us what she thinks a medicine is, despite my making a point of order. Whatever side of the argument one is on, that is important. Whether or not one believes that fluoride should be added, people must be protected by a proper
 indemnity policy, and if that is unnecessary, the Government should not have to put it in the Bill.
 Either way, we deserve answers and we are not getting them from the Minister. Her remark about how many countries use fluoride was unbelievable. It stretched the patience of the Committee well in excess of what we are used to, especially on this Bill. We can start with Switzerland, where the canton of Basel has given up fluoride—

Nick Palmer: I am familiar with the situation in Basel, as I lived there for 18 years. Does the hon. Gentleman agree with the Swiss policy of putting fluoride in salt?

Bill Wiggin: I am not convinced by what I have seen of the scientific research that says that fluoride should be put in the water in Britain. I am more than happy to keep an open mind about the advantage of putting fluoride in toothpaste, and giving people fluoride pills if they want them, but I am not convinced that the way in which the Government are setting out to provide fluoride for British people is necessarily the best way. I started the debate with an open mind and I have asked many questions that would be helpful if they were answered, simply in respect of protection, if nothing else.
 The York report stated neither that fluoride should or that it should not be added. It concluded that more scientific research was needed to answer the questions and allow us to proceed with comfort, and that would probably mean that the indemnity proposal would not be necessary. None of the report's conclusions have been taken up. The Minister was floundering about whether the Bill lived up to its human rights obligations.

Norman Baker: Perhaps the hon. Gentleman can help me answer a question that came to mind after the Minister sat down. In response to an intervention by the hon. Member for Ceredigion, the Minister said that there is an indemnification process in the Water Resources Act 1991, so I am not clear why indemnification is needed in the Bill. If the situation is hunky-dory, why is indemnification needed, and if it exists in the 1991 Act, why does it have to be replicated? It makes no sense to me.

Bill Wiggin: The hon. Gentleman is absolutely right. The debate shows more and more that the Bill has not been properly thought through. Which Department will have the money for indemnification taken out of its budget? Will it be the Department of Health? How many hospital beds will be lost because of the bad wording of the measure?

Melanie Johnson: That is not how the finances of bearing risk internally work. Does the hon. Gentleman not understand that?

Bill Wiggin: How can I understand it when the Minister never answers the question? It is not very difficult. Can you tell us, Minister, how much money you are preparing to put aside to pay for litigation? If you have any idea how much you have been advised it may cost, tell us. We have no obligation to accept anything other than your word as to its being true—

Bill O'Brien: Order. I draw the Committee's attention to the fact that hon. Members are asking one another questions, rather than me. It would be helpful if hon. Members of all parties would address their remarks to the Chair.

Bill Wiggin: I am delighted to address my remarks to you, Mr. O'Brien. I apologise if in my excitement I did not do so.

Nick Palmer: The hon. Gentleman alleges that the Minister does not answer his questions, but he has not answered my question. He gave Switzerland as an example, and I pointed out that the Swiss policy is to put fluoride in salt, which virtually everyone consumes. Does he withdraw his suggestion that Switzerland is not a proponent of the general use of fluoride?

Bill Wiggin: I tried to answer the hon. Gentleman's question by saying that my mind is open about whether it is a good thing. I am sorry if he did not get that. I do not object to people choosing fluoridation—the hon. Member for Ceredigion said that he used fluoridated toothpaste—but I want to ensure that there is a proper process to indemnify water companies. This is not a complicated part of the Bill, but the Committee is not getting the answers it needs. I want to know how much the proposal will cost, what legal advice is being taken, and whether the Bill fulfil its human rights obligations, as it states on the front page. They are not difficult questions, but it is only fair that we get some answers from the Minister.

Simon Thomas: In case there is any misunderstanding—and the Minister was trying her best, though perhaps without complete success, to misrepresent my position—I want to clarify something. Nothing that I have said on indemnities, and the possible health reasons for indemnifying water companies against the addition of fluoride to our water supply, has come from anywhere but the York review. That review asked for further high-quality research, but the Minister said that she would prefer to take the advice of the Medical Research Council. As a layman, that leaves me in a quandary, because she also said that fluoride is not a medicine. The process of licensing medicines in this country will not deal with fluoride because it is not a medicine, but the advice is being given from the Medical Research Council, which I believe covers medicines—I am not 100 per cent. sure; perhaps it covers poisons—and research on the effect of medicines on human health. The council is advising the Government on a substance in the water supply that is not a medicine. If the Bill were used to bale out a ship, we would not get very far, because there are so many holes in it.

Nick Palmer: I want to clarify that point. Does the hon. Gentleman agree that the Medical Research Council's job is to study alleged risks to human health, regardless of whether they are caused by medicines or by other substances?

Simon Thomas: That is my quandary. I thought that the point of the York review was to consider all the evidence and scientific studies carried out on the addition of fluoride to the water supply and produce a
 set of recommendations, which the Government would then act on before they added fluoride to the water supply, an act that raises the question whether we need an indemnity for water companies. The Government have not done that.

Richard Burden: I get the impression that the hon. Gentleman is taking several things from the York review that were not in it. He said that the Minister prefers to accept the advice of the Medical Research Council, but she has said nothing to indicate that she has refused to accept the York review, and he himself made the point that the York review did not offer advice. It was a review of evidence, and it concluded that there must be further research. Nobody has disagreed with that. The question is what public policy to adopt while that further research is being done, which is a judgment that we all must make, but there is no question of accepting the MRC and not the York review.

Simon Thomas: The hon. Gentleman is more or less on track with that comment, and I do not disagree with his analysis. However, the York review said that we must have further high-quality research on IQ, which has excited some members of the Committee, and perhaps on other fields as well. The Medical Research Council said that that is a low priority. Even if we accept the hon. Gentleman's point that that is the correct process, the Government also told us more than a year ago that there will be a report from the chief medical officer and the chief dental officer, and we still have not seen that report.
 We seem to be legislating, and indemnifying water companies against the addition of something to our water supply that is not a medicine, but is supposed to have a health benefit, on the basis of peer and scientific reviews that do not reach firm conclusions. That is not the right way to legislate. We should wait at least for the report of the chief medical officers. Until we know what further research the Government will commission, I am not happy to leave it to regulations from the Department of Health. Members of Parliament do not have the time and space to scrutinise those properly. We should scrutinise the primary legislation, not the regulations. We are trying to regulate through the back door in a clause that was added to the Bill, and we are doing so without the full facts and information at our fingertips. 
 There are huge disagreements between people—both scientists and the public—about whether we should put fluoride in our water. As a general principle we should not legislate to extend, or encourage the extension of such provisions, as the Government are trying to do, unless we are convinced about whether such moves are harmful or non-harmful.

Bill Wiggin: I agree with the hon. Gentleman. Does not he agree that perhaps the reason that the Government will not admit that this is a medicine is that they do not want to have a mass medication debate? They have, however, failed to give us an alternative of what they really believe it is.

Simon Thomas: The hon. Gentleman may be right. There is also the problem of trying to register as a
 medicine something that is already in the Poisons Act 1972. That would have to go to the Medical Research Council. There would have to be a huge amount of testing on the population. I am sure that he is, like me, vaguely aware of how a medicine is introduced: it must be done through peer review and must be introduced gently to the human population via review groups, and so forth. However, that has not happened. Fluoride is not accepted as a medicine. Perhaps it would be better if it was treated as a medicine and we could consider whether it has positive medical effects.

Brian Iddon: Does the hon. Gentleman accept that there are certain things called trace elements that are necessary for life, such as vitamins and many minerals. Selenomethionine, for example, is a means of supplementing the supply of selenium into the body. Would he consider those to be medicines? They come under the Medicines Act 1968, but I do not think that even the Medicines Control Agency considers them to be medicines. They are trace elements that are essential to good health.

Simon Thomas: I must be careful how I use my words—the word ''force'' comes to mind. Those trace elements are available in food and, to some extent, in the water supply, but we do not deliberately add them. As the hon. Gentleman may be aware, in this country iodine is added to salt, and a vitamin is added to flour—that is a hangover from the second world war.

Diana Organ: And margarine.

Simon Thomas: The hon. Lady may be correct.
 We do not indemnify those companies against the addition of such things in our food supply, so why are we indemnifying water companies against fluoride? I think that it is because the Government know that the science is still a bit shaky. They are not 100 per cent., and they want to cover their back.

David Drew: I wonder whether the hon. Gentleman will carry the logic through. There could be a case for the Government being asked to indemnify companies that introduce genetically modified food into the food supply. The logic of what he said could, without doubt, be followed through.

Simon Thomas: Could be—but perhaps not on this occasion. We note in passing that the Co-op has decided not to stock GM foods. Perhaps there are individual decisions to be made.
 We should not try to indemnify water companies for something that the Government are not 100 per cent. sure about in terms of scientific and medical advice. I am not convinced. The Government are trying to cover their back for what could be horrendous—and horrendously expensive—litigation processes. The hon. Member for Leominster asked about costs. We have none of the information we need to take decisions on in primary legislation.

Nick Palmer: I want to reserve my main comments for the stand part debate. Some hon. Members have been smuggling in a stand part argument. They are saying that they are sceptical about the addition of fluoride and would not like to see the indemnity. It
 seems illogical that we will have the opportunity to vote on whether the responsibility for the addition of fluoride should pass to the health authority, but if the Government's view is followed and that responsibility is passed on, we should not indemnify the companies that we are asking to take on that responsibility. That would be grossly unfair to them. I am therefore puzzled about amendment No. 220.

Paddy Tipping: Does my hon. Friend take my view that all the political parties have agreed that when the Bill goes back to the Floor of the House there should be a free vote on this clause? Is it not more appropriate to vote on that issue on the Floor of the House rather than in the Committee?

Nick Palmer: I do not have a strong view on that. There are plenty of precedents for voting on it in Committee. However, my hon. Friend may be correct that the issue has attracted sufficient broad concern—
Several hon. Members rose—

Nick Palmer: It seems that I am in popular demand. It might be appropriate to vote on the clause on the Floor of the House. I give way to the hon. Member for Leominster, with whom I entirely agree on motor cycles.

Bill Wiggin: I am grateful to the hon. Gentleman on two counts. He is right to make his comments now, because there is always a risk that the clause stand part debate will not be reached. He suggests that some of us are what I might call fluorosceptics, among whose number I think he includes me, although that would not be strictly true. The purpose behind our inquiries is to find out whether the best way for the Government to achieve proper fluoridation and the benefits—

Bill O'Brien: Order. Hon. Members are addressing one another. They must address the Chair.

Bill Wiggin: The age group with which we are primarily concerned is between seven and 12. If the best way to achieve dental protection for that age group is through adding fluoride to the water, we must make that judgment based on the facts and figures, which we rely on the Government to supply. If, on the other hand, the Bill for indemnifying water companies is so enormous, perhaps the Government should be exploring other methods, such as giving fluoride pills or fluoride toothpaste and toothbrushes to schoolchildren. We are trying to tease that out of the Government, but they say that there is no bill. However, there must be a bill if they are going to pay for proper protection.

Nick Palmer: The indemnity is an example of the precautionary principle at work. It would be possible for the Government to indemnify private operations against any conceivable frivolous litigation that might take place. However, in this case, we are all aware of the risk that groups who feel strongly about the issue might initiate litigation, which, even if it is unlikely to succeed, could be quite expensive. If we in Committee and on the Floor of the House consider that fluoridation is in the public interest, it would be fair to the companies that are affected to cover the cost.

Simon Thomas: I want to put on the record, with regard to what the hon. Member for Sherwood (Paddy
 Tipping) said about a free vote on the Floor of the House, that following my party's annual conference this year, we will not have a free vote. We will vote against.

Nick Palmer: I am shocked to hear of the Stalinist discipline that operates in the Welsh National party and sympathise with the hon. Gentleman, who is probably struggling with his conscience.

Norman Baker: Can the hon. Gentleman help me on one point, or if he cannot, perhaps the Minister can—assuming that she will be returning to answer some of the points raised? If, as the Minister said, water companies are already indemnified under the Water Resources Act 1991, why is the clause needed?

Nick Palmer: I am not an expert on the interaction between different pieces of legislation, so I will leave others more expert than me to answer that question. I shall defer any further remarks to the stand part debate.

Melanie Johnson: I will first address the question, by which the hon. Member for Lewes seems very excited, about why the measure is in the Bill. As I have said, section 90 of the Water Industry Act 1991 makes similar provision. The new section is a substitute for section 90 and takes account of the new procedure on fluoridation. It is as uninteresting as that.

George Osborne: Is the indemnity really necessary? The Government are the guarantor of last resort in major public health issues—that is what the Minister of Agriculture, Fisheries and Food said during the BSE crisis. At the time, the Department of Health provided predictions to Ministers that up to 5 million people could die as a result of CJD, and the Government would have been the guarantor if a public health catastrophe had unfolded. If fluoride turned out to be dangerous to human health and there was a widespread medical disaster, the Government would have to step in and spend an enormous amount clearing up the mess whether or not the new section was in the Bill.

Melanie Johnson: Let me say in the strongest possible terms that there is no evidence of any harm to overall health from fluoride. I want to make that clear to anyone who has any doubt about it. For more than 40 years in the UK, we have had a large trial of the trace element in our water. More than 6 million people in the west midlands and the north-east already receive fluoridated water, and there is no evidence of harm to overall health as a result.
 That is backed by evidence from many countries around the world. The hon. Member for Leominster did not pick up on the point made by my hon. Friend the Member for Broxtowe (Dr. Palmer), which was that the Swiss fluoridate salt. Many other countries also do that, so the population absorbs fluoride through salt consumption as well as water consumption in some cases.

Hugo Swire: Will the Minister pause to answer the question posed by my hon. Friend the Member for Tatton (Mr. Osborne)? The Government are the guarantor of last resort in all
 instances of health. If so, why is the new section needed?

Melanie Johnson: I have already explained that, but hon. Members do not want to hear it. The explanation is that the water companies have asked for a level playing field on the risks that they face whether they fluoridate or not, and it is entirely right to provide that. We do not have a massive costing that suggests a huge liability. It is entirely to the contrary: there is no expected liability.
Mr. Osborne rose—

Melanie Johnson: I will finish answering the hon. Gentleman's earlier remarks and then let him intervene if he wants to.
 There is no expected liability. Only £500 has been paid out in the past five years under the indemnity in the Water Industry Act 1991, and that covered the costs incurred by a water company in prosecuting the non-payment of one bill, which I mentioned earlier. We are talking not about £5 million or £5 billion, but about £500.

George Osborne: Each Committee member will have received a host of correspondence from several organisations that are against putting fluoride in water. It is predictable that at least one, if not many, will mount a legal challenge. The Government must be forecasting that they will pay out for legal costs in the simple expectation of such legal action. I am not talking about their paying hundreds of millions of pounds because people are ill.

Melanie Johnson: I have already said no, and when I say no I mean no. How many times does the hon. Gentleman want me to say it?

Norman Baker: I entirely accept the Minister's point about indemnity and the Government's theoretical position. However, following on from the Birmingham example, is it not the case that if there was a campaign of non-payment of water bills as a consequence of fluoride being added, the water companies would happily pursue cases through the courts in the knowledge that the Government would pick up the bill for the prosecution?

Melanie Johnson: No, no, that is not the case. As I pointed out, there are 6 million consumers already—across swathes of eastern England, from the north-east to Essex, and in a chunk of the Birmingham area—who are already receiving fluoridated water.

Norman Baker: As the Minister told the Committee a moment ago, under the 1991 Act the only time that the Government have had to cough up money is to provide the fund for the prosecution of the water company in the case of that one individual in Birmingham. It follows that, unless the indemnity provisions in the Bill are altered, they will give an undertaking to water companies to provide funds for prosecution in the case of non-payment where fluoride is an issue. The Birmingham case could happen again. I want the Minister to confirm whether that still remains the position under the new provisions.

Melanie Johnson: We will need to discuss the exact nature of the provisions when we discuss the affirmative procedure. I was distressed by the comments of the hon. Member for Ceredigion about the scrutiny that this House provides for regulations subject to affirmative procedures. I take it that when he comes to a Committee dealing with such regulations, he does not take his responsibilities seriously or he does not think that others do so. The fact is that there is a good, solid opportunity for detailed debate when dealing with regulations subject to the affirmative procedure.

Hugo Swire: A few days ago, or even last week, before the Minister came to this Committee and illuminated us all, the Minister for the Environment talked about the large amount of debt that was owed because of non-payment of water bills. The Minister has cited the Birmingham example, but can she envisage a situation whereby others might cite the reason for non-payment of bills to be the fluoridation of their water supplies?
 Will not the Government find themselves having to distinguish between those who are refusing to pay their bills on principle because of water fluoridation and those who did not want to pay their bills anyway? The Government could find themselves, on one hand, supporting the water companies' legal cases with public money, and, on the other, not pursuing individuals for non-payment, because so far they have failed to pursue unpaid water bills amounting to £700 million or £800 million.

Melanie Johnson: The hon. Gentleman is one of a number of people who are using the discussion as an opportunity to try to oppose fluoride, while not being as intellectually honest as those who simply say that they oppose it for whatever reason. The attempt to manufacture shroud after shroud out of tiny tatters of cloth is feeble.

Hugo Swire: Answer the question.

Melanie Johnson: The answer is that we do not envisage the problems that the hon. Gentleman outlined. I have already made that absolutely clear in response to the hon. Member for Tatton.
 I was struck by the remarks that the hon. Member for Ceredigion made about his party's position on the matter; he said that he believes in individual liberties, but that his party will not have a free vote on the subject. That is interesting. 
Mr. Thomas rose—

Melanie Johnson: I see that I have touched a nerve. I shall give way to the hon. Gentleman.

Simon Thomas: I really cannot believe that I need to tell the Minister this, but in order to protect individual liberties, we sometimes have to take a stand and say that we will not legislate for measures such as identity cards or compulsory fluoridation.

Brian Iddon: Or seat belts.

Simon Thomas: Yes, or seat belts, but there is greater public benefit to be gained from that measure, because of its effect on other people and the health service, so that is a different matter.
 It would be better and more intellectually honest, to use the Minister's words, of her to say whether the Government are in favour of fluoridating our water supply, than to hide the measures in the Bill, which is what she is trying to do.

Melanie Johnson: We are certainly not hiding the measures in the Bill. We are leaving local communities to decide. I do not know whether the hon. Gentleman believes in devolution, but Labour Members certainly do. Our position is entirely consistent.
 I now come to the MRC. I am grateful to my hon. Friend the Member for Birmingham, Northfield (Richard Burden) for his remarks. He was entirely right in setting the hon. Member for Ceredigion straight about what I said. I had not made the connection with, or the rejection of, the York report that was suggested. The MRC was asked to advise on how the gaps in the research which the York report identified could be filled. That is the work that the MRC was asked to undertake. The York report was basically a review of the evidence, and it said that much of the so-called evidence was not very well researched, and that more work needed to be done. That is what the MRC programme is designed to do. 
 On the question of so-called medication, and the definition of ''medicine'' that so excites the hon. Member for Leominster, the Medicines and Healthcare Products Regulatory Agency does not consider fluoridated water a medicine, and it is the agency responsible for defining medicine. We have to remember that fluoride is a natural constituent of all drinking water. Indeed, the bottles before us contain just under 0.02 mg per litre of fluoride.

Robert Key: At 8 to 12º C.

Melanie Johnson: The hon. Gentleman has been studying intently on the Back Benches, and I am delighted to see it.
 Fluoride sometimes occurs naturally at much higher concentrations than 1 part per million. Some areas have had the fluoride levels in naturally fluoridated water reduced to bring the content down to the levels considered optimal and entirely safe. It is entirely natural that we take in fluoride in a variety of ways. My hon. Friends the Members for Broxtowe and for Bolton, South-East remarked that it is found naturally in food, and that we need to take it in. That is why fluoride is not a medicine.

Bill Wiggin: I am glad that the Minister has addressed the question. If fluoride is already in bottled water, why do the Government's proposals not insist that all bottled water contains fluoride?

Melanie Johnson: We are not insisting that all of anything should contain fluoride. As I said earlier, we are talking about options and about the devolution of decision making to communities. That is what already happens; some communities in England already have fluoridated water, and others do not. That is how it should be.

Brian Iddon: I just want to correct the point that I made earlier about comparing fluoride as an essential element with vitamins and minerals. I referred to vitamins and minerals as being regulated by the
 Medicines Control Agency. I apologise; I was wrong. Vitamins and minerals are regulated through food legislation. That strengthens the point that I was trying to make to the hon. Member for Ceredigion.

Melanie Johnson: Indeed it does. As a Minister, I deal with vitamins and minerals through the Food Standards Agency. Can I therefore bring this interesting debate, which I am sure will be resumed on other amendments, to a close?

Norman Baker: I am still keen to know about the position of private water suppliers, which has not yet been addressed. If a private water supplier wished to add fluoride to water, would it be indemnified against any action in the way that water undertakers are? If not, is the Minister happy that the benefits of fluoride—as she sees them—will not be available to those who benefit from a private water supply?

Melanie Johnson: I am not sure in what sense the hon. Gentleman uses the word ''private'', because all the companies are private.

Norman Baker: I understand that the Minister will not necessarily be up to speed with water legislation, but about 2 per cent. of suppliers are officially called ''private''. That has nothing to do with private companies, but where water is supplied by, for example, an estate. I am keen to know whether those suppliers will be indemnified in the same way as water undertakers.

Melanie Johnson: Yes, the hon. Gentleman's point reflects the Government's desire for everybody to be on the same footing—to have a level playing field.
 I trust that I have responded sympathetically to the issues and that hon. Members will support the Government amendment.

Bill Wiggin: Before the Minister makes her closing comments, I want to ask her about Government amendment No. 343. I notice that it states:
''The Secretary of State may also, with the consent of the Treasury, agree to indemnify''.
 Can she confirm that the wording does not mean that if the Secretary of State is willing to indemnify the water companies, but the Chancellor says no, the amendment would be worthless? Is the Treasury's consent needed to provide the level playing field to which the Minister referred?

Melanie Johnson: I am grateful to the hon. Gentleman for his remarks. He makes a good point. I mentioned the Treasury in my opening remarks. The Treasury is normally involved in these financial discussions for all Departments. I am sure that the hon. Gentleman appreciates that, whatever the measure says, it is unlikely that the Treasury would be not strongly involved in any such situations that occurred. It is unlikely that it will ever be an issue in the way that has been envisaged.
 I ask hon. Members to support the Government amendments. I hope that Opposition Members will reflect on the opportunity for a fuller debate on the details of the exact liabilities. The appropriate time for that detail to be worked out is when the regulations are considered.

Bill Wiggin: I am grateful to the Minister for her closing comments. The Opposition's position is that this is a free vote, and will be the position throughout the debates today and with regard to the latter parts of the Bill. This is an important part of the Bill. It is difficult for me, having teased out quite a lot of information from the Minister, to oppose amendments that are almost identical to mine.
 The wide-ranging debate is important because this is a crucial consideration in protecting people. I should have liked more detail about how the Government would handle a disaster, but my hon. Friend the Member for Tatton put that question very nicely, and the Government's response will be on the record. I am grateful to the Minister for what she said. 
 Amendment agreed to.

Bill Wiggin: I beg to move amendment No. 213, in
clause 61, page 76, line 30, at end insert— 
 '(2A) Neither shall a water undertaker be required by subsection (1) above to enter into any such arrangements unless and until it has been ascertained (pursuant to the provisions of section 89 below) that at least 90 per cent. of the population residing within the area proposed to be fluoridated are in favour of the fluoridation of their water supply.'.

Bill O'Brien: With this it will be convenient to discuss the following:
 Amendment No. 351, in 
clause 61, page 76, line 30, at end insert— 
 '(2) With regards to Wales, neither shall a water undertaker be authorised by subsection (1) above to enter into any such arrangements unless and until a referendum on increasing levels of fluoridation has been held in accordance with the Political Parties Elections and Referendums Act 2000 seeking approval of the arrangements from the population residing in the area proposed to be affected.'.
 Amendment No. 156, in 
clause 61, page 79, line 19, after 'below', insert 
 'the Secretary of State must ensure funding is available for the consultation to take place as set out below, and'.
 Amendment No. 110, in 
clause 61, page 79, line 21, after 'consult', insert 'all households'.
 Government amendment No. 338. 
 Amendment No. 158, in 
clause 61, page 79, line 22, at end insert 
 'then if public opinion is clearly in favour of such an addition'.
 Government amendments Nos. 339 to 342.

Bill Wiggin: Amendment No. 213 covers the two important aspects of consultation. The Government have put the strategic health authorities in charge of the consultation, and they are neither accountable nor democratically elected. The Government have also failed to answer the question of what would happen if one strategic health authority wants fluoridation, but another does not—which would take precedence? There will be overlaps in water supply areas, and it is impossible to separate those who want fluoridation from those who do not.

Simon Thomas: Will the hon. Gentleman consider the fact that there are overlaps not only in water supply, but in strategic health authorities? In Wales, different
 trusts overlap; for example, mental health trusts and so on. There may be disagreements among bordering health authorities over an area that has more than one water supply. His amendment goes to the heart of the matter of how to address public consultation.

Bill Wiggin: The hon. Gentleman is right, and his amendment No. 351, which is included in this group, touches on the sensitive issue of Wales, which is greatly relevant to my constituency.
 A third question is how the consultation will be funded, because it is not cheap. We all know that the Government have done all that they can to invest more money in the health service, but will the funding come from the health service budget or another budget? How much will it cost? What will a strategic health authority be expected to spend on consultation, if indeed the authority is to pay? I would prefer an element of democratic decision making with local authorities having that power.

George Osborne: My hon. Friend has touched on an important point. Even those of us who are neutral on whether to put fluoride in water feel that strategic health authorities are the wrong vehicles for the measure. In my constituency, we are governed by the Cheshire and Merseyside strategic health authority, which covers a vast area and is not locally accountable. The Minister talks about the decision being given to local communities, but nobody can call the strategic health authority representative of the local community. A local authority would be a better guide to local opinion.

Bill O'Brien: Order. I draw Members' attention to the fact that the involvement of local authorities is covered by amendment No. 301. I hope that they will reserve remarks on local government for discussions on that amendment.

Bill Wiggin: How lucky we are to have you in the Chair, Mr. O'Brien.
 In amendment No. 213, I have suggested that at least 90 per cent. of the local population should be in favour of fluoridation.

Andy King: I find the amendment fascinating, especially as the hon. Member for Tatton said that he is being open-minded and not sceptical about it. Does the figure of 90 per cent. refer to the proportion of those who vote or, as I interpret it, the proportion of the whole population? Has he ever known a vote in which 90 per cent. of the population even turned out to vote? The amendment is absurd.

Bill Wiggin: The hon. Gentleman is right; it is a wrecking amendment, and I have no problem with saying that. We want to find out from the Government what democratic result they would consider right. I have taken this to the nth degree purely for that purpose. I am grateful to the hon. Gentleman for making half of my speech for me.

Nick Palmer: We all appreciate the hon. Gentleman's openness and honesty about his wrecking intentions. Could I draw his attention to the fact that the Leader
 of the Opposition, before he became distracted by other matters, spoke scornfully about the idea of referendums on fluoridation? Is he concerned that his recommendation will lead to career discussions?

Bill Wiggin: There is an important point that both hon. Members have made: what democratic accountability will we accept for this important procedure? I am more than happy to accept that 90 per cent. may not be the right figure, but I am keen to find out what the right figure is and how much democracy we will be exposed to. If strategic health authorities conduct the accountability element of the decision to fluoridate, we may have ridiculous results. That might make my amendment absolutely credible.

Hugo Swire: Does my hon. Friend share my concern that, as with the Government's intention to introduce regional assemblies, if some areas do and some do not, the Government will go on applying pressure until all areas comply with what is essentially Government policy?

Bill Wiggin: My hon. Friend makes an important point. The sinister aspect to what he suggests is that there is so much pressure on one side of the argument, so how can we ensure that we have a proper and fair debate with good information that is well understood by all?

George Osborne: My hon. Friend is making a good point. No one seriously believes that strategic health authorities such as Merseyside or Manchester will not, after carrying out some cursory consultation, introduce fluoride into the water. They know what happens. When people are asked about fluoride they almost always reject it in large numbers. As the hon. Member for Bolton, South-East will remember, in 1968 when the people of Bolton were asked in a referendum, 73 per cent. said no to fluoride. I imagine that the result would be replicated today.

Bill Wiggin: My hon. Friend is absolutely right. One must bear it in mind that, according to the statistics that the Minister quoted, if one held a referendum in Birmingham, only one person would vote against fluoridation.

Simon Thomas: The hon. Gentleman is dealing with an important point—how do we gauge public acceptance? In the context of Birmingham, he may be interested to know that the Islamic Medical Association has announced that it is launching a campaign to stop artificial fluoridation in Birmingham. [Interruption.] What he has just predicted is about to come to fruition. Would not such a campaign affect the result of the referendum?

Bill Wiggin: I, too, have had a letter from that organisation. I notice that the Minister for the Environment said from a sedentary position, ''All two of them.'' There are 2 million of them. I am surprised that the Minister is so relaxed about it. Let us have no fatwas on water.
 The important point is that the Committee has to decide what sort of democratic result we would be prepared to accept. Perhaps I was a little harsh on myself when I described this as a wrecking amendment. It is intended not to wreck but to 
 probe, and it has been extremely successful in that respect. I should like the Minister to deal with the key points. What democratic accountability are we prepared to accept? Who will pay for the consultation? If we have a split result where one strategic health authority wants one thing and one wants another, who will win? How much accountability will people really get from the process?

Nick Palmer: My impression, Mr. O'Brien, is that you are allowing us to range reasonably widely around the clauses, so with your permission I will make some remarks that I might otherwise have made on clause stand part. I will try to stick as closely as I can to the amendment.
 I am grateful to the hon. Member for Leominster for raising these issues. However, I am still in the dark about whether he is in favour of referendums: he said that he is trying to probe whether the Government are in favour of them, but I am not sure whether he is. Opinion polls suggest that 55 per cent. of the population are in favour of fluoridation. In an individual referendum, the result might be different. I am happy to allow the hon. Gentleman to intervene to clarify his views, if he wishes to do so.

Bill Wiggin: I am grateful for that invitation. I always seek to clarify my views, although, unfortunately, the decision on this matter will be taken by the Minister rather than me.
 I am in favour of referendums on whether fluoride should be added to water, but I do not agree with the provision for holding those referendums. I would hate for fluoride to be added to the water without a referendum, but I am unsure whether the people who would conduct the referendum are the right people. Does that explanation help the hon. Gentleman?

Nick Palmer: I must admit that I am struggling.

Bill Wiggin: Shall I have another go?

Nick Palmer: First, let me explain what I understood the hon. Gentleman to be saying. His amendment is based on the view that referendums conducted by the strategic health authority would be undesirable if the vote was in favour, but he would be happy if the vote was against. Is that right?

Bill Wiggin: That is very wrong. I said that fluoride should not be added to water unless there has been a referendum—in that respect, I am in favour of referendums. However, I am not in favour of the referendums set out in the Bill, which would be conducted by strategic health authorities, which have very little democratic accountability. I would prefer them to be conducted by people who understand about votes, such as local authorities.

Nick Palmer: I now understand the hon. Gentleman's position, which I must say, if he will excuse my rudeness, is odd, because most people are more concerned about what they are voting on than about who organised the vote.
 I turn to the substance of the amendments. There are four separate issues. The first is whether fluoride is at all helpful to teeth. Although, as with the Burns inquiry on fox hunting, we all quote the bits of the York review that we like, leaving aside all minor 
 issues, there is no serious dispute about whether fluoride reduces decay; it does. We can argue about how much it reduces it, but almost everyone agrees that it has a positive effect. 
 The second issue is whether we can be certain that fluoridation is not harmful to health. One cannot prove a negative. It is possible that chlorination is harmful to health. It is also possible that the electricity network is harmful to health, and I have constituents who believe that, if power lines pass somewhere near their house, that is likely to make them ill. One has to make a judgment about whether such fears are reasonable. 
 I am not an expert on fluoridation, but the York review and the MRC's comments suggest that there is no good reason to believe that fluoride is harmful to health. There has been extensive correspondence on this matter from different groups. There are issues that continue to be raised, and we should continue to respond to them—to listen attentively and see whether our judgment changes. 
 The third issue is about freedom, which the hon. Member for Ceredigion mentioned. I was struck by his view that in order to protect freedom it is necessary to abolish freedom. I think that he said that it was necessary to take a stand, but that stand is one of compulsion, regardless of the views of the individual members of Plaid Cymru. That is an original position, but I shall pass over it.

Simon Thomas: Will the hon. Gentleman tell me the last time that the Labour party gave its MPs a free vote on anything in this place?

Nick Palmer: Yes, today. Moving aside from what one might call partisan banter, there is a serious issue about freedom. If there was any serious evidence of probable harm, even to a small section of the population, we would need to take the matter seriously. However, as long as we believe that there is no serious evidence of probable harm, the collective cost to all of us of the national health service entitles us to adopt what we believe to be safe ways of improving the nation's health.
 Some of my constituents object to safety warnings on cigarette packets: they say that they are nanny stateism, that they are irritating and a waste of public money. The argument in that case, as with the banning of cigarette advertising—some of my constituents object to that as well—is that because we collectively pay for health care, it is reasonable to take steps to protect the nation's health, if those steps do not inflict damage on individuals. Most of us would feel that the damage to individuals of having to read an irritating warning on a cigarette packet is so trivial that we would not worry about it. The question is whether the risk posed by fluoride is equally trivial.

Norman Baker: The hon. Gentleman has correctly identified the three issues at the heart of the debate. They are the quantifiable benefits and risks, such as they are, and the melding together of those two aspects with the question of individual freedom—that is the crux of the Bill. However, I do not agree with his
 application to tests. He has not mentioned the precautionary principle, which is the standard approach taken to environmental and health matters, and I ask him to address that point.People may have concerns about power lines, for example, but they do not have to live next to them. They may object to the warnings on cigarette packets, but they do not have to buy the cigarettes, or they can buy them and still object to the warnings. The difference with fluoride in water, and what makes it such a sensitive issue, is that once fluoridation has taken place, people have no alternative but to drink that water. That is my greatest concern, and suggests to me that the test that is applied should be a lower test than in cases in which there is genuine freedom of choice.

Nick Palmer: I appreciate the logic of what the hon. Gentleman says, but the cases are less different than he thinks. If people feel strongly about wishing to avoid power lines, they may be forced to live in a less attractive property than they otherwise would, and may feel that they are losing out. Constituents who object to fluoridated water do not object because they would be forced to drink it, but because they would be forced to buy bottled water or filters, and they do not see why they should have to put up with that extra cost. It is not that they are being forced to consume it, but that they are being forced to pay something because of their beliefs.

Hugo Swire: I am following carefully what the hon. Gentleman says, but the logical conclusion of his argument is that we have responsibility for the nation's health. If that is the case, and there was an explosion of disease as a result of the lack of, or a decline in MMR inoculation, as is currently occurring, at what point should the state step in and say that, in order to protect the whole, it must insist on compulsory vaccination? Surely it is a fundamental medical principle that no one should be forced to accept medication?

Elliot Morley: It is not medication.

Hugo Swire: The Minister may say that, but—

Bill O'Brien: Order. This is an intervention, but it is becoming lengthy.

Hugo Swire: What the Minister says is contrary to what the EU says. I invite the hon. Member for Broxtowe to reflect on the logical outcome of his conclusion, because I find what he says worrying.

Nick Palmer: I appreciate that there are important issues around MMR, but I think you would lose patience with me, Mr. O'Brien, if I went down that route. Although I have strong views on the issue, I shall not ventilate them today.

George Osborne: The hon. Gentleman is making an interesting speech. I am not tempting him into a debate about vaccination, but my hon. Friend the Member for East Devon (Mr. Swire) made a good point: some countries have compulsory vaccination. In the United States a child cannot go to a public school without having had the MMR jab. There may be a
 case for compulsion with regard to public health issues, whether it concerns fluoridation, vaccination or any other matter.

Nick Palmer: There is a case for compulsion in respect of vaccination, but we are not discussing that today. As I said in my reply to the hon. Member for Lewes, we are not discussing compulsion on consumption of fluoridation, but whether the cost should lie principally with those who want to have fluoride, by forcing them to buy fluoridated toothpaste, or with those who have an apparently unreasonable fear of fluoride, who would have to buy bottled water.
 I realise that I forgot to respond to what the hon. Member for Lewes said about the precautionary principle. I apologise for that. We all use the words ''precautionary principle'', but in practice we accept that a reasonable limit must be applied. There are some people who believe that practically any substance known to mankind is dangerous and that they are constantly at risk from everything around them. It is possible that we are all developing cancer as a result of sitting in this warm Room. The precautionary principle might suggest that we should not sit in warm rooms, but one has to draw the line somewhere. The question is whether the line is being drawn at a reasonable point in the Bill. 
 Ultimately, somebody must decide. We must decide whether the risks outweigh the benefits, or whether they are negligible, as far as we can see, and are outweighed by the benefits. Who decides that currently? It is the boards of the privatised water companies. That is totally bizarre. I am not one of those who bash industry. I worked in private industry for 18 years and I have absolute respect for people sitting on the boards of private companies. If they take their job seriously, let them get on with it—that is fine. However, people are not selected as directors of Severn Trent for their medical expertise. 
 The arguments against fluoridation would lead to a proposal to ban it. However, the proposal before us is not to insist on fluoridation but to transfer the decision-making competence from the board of privatised water companies to the health authorities. If somebody has to make the decision in the light of the amount of fluoride in the local water supply, the state of the local teeth, and so on, the best option is likely to be the health authority.

Bill Wiggin: The strategic health authorities are fairly new. Who does the hon. Gentleman think is more accountable to the public, the current board of the water companies, which have a wide shareholder ownership and customer base, or strategic health authorities? The latter are neither elected nor even nameable in most cases.

Nick Palmer: If I wanted a body to decide how to maximise the profit from the water supply, I think Severn Trent would be in a much better position to do so than the East Midlands strategic health authority.

Richard Burden: It should be on the record that the Opposition spokesman stated that a private company is more accountable than the national health service. It
 ends the debate about whether they want to privatise it.

Nick Palmer: The logical conclusion of the view expressed by the hon. Member for Leominster is that responsibility for the local health service should be transferred to the management of the water supply company.

Siôn Simon: Does my hon. Friend believe that the first and only single piece of shareholder power in the history of capitalism has gone to the hon. Member for Leominster's head?

Nick Palmer: I will not speculate about the hon. Gentleman's thought processes, which have a logic that is not always perceived from the outside.

Bill Wiggin: I am glad that I have caused the Committee so much amusement. We are talking about the power going the other way, from the shareholder board to the strategic health authorities. I am grateful for the interventions, as it shows that hon. Members are listening. I am keen to ensure that there is more accountability, not less. That is what I sought to tease out from the hon. Gentleman, despite the jibes from Labour Members.

Nick Palmer: The hon. Gentleman is making serious points. Most people, when asked about fluoridation, say, ''Well, it's probably a good thing, although I don't understand all the details.'' Some, however, say, ''I'm a bit worried about it. It seems a bit spooky.'' Only a limited number of people, who are in a position to decide, having fully examined the arguments on both sides, feel totally confident about the issue. The call for a national referendum would not be as widely supported as the hon. Gentleman thinks. Most people would want a substantive consultation in which the health authority, working with local government, tried to ensure that the arguments were well understood, and that people had the chance to respond fully to the process.
 I am not sure that asking people to vote is the best way to solve the matter. I do not feel able to assess every argument that has been advanced, and I have spent a lot of time reading up on the issue. What is needed is the best possible advice from health experts on both sides of the argument, and a health authority is probably the best place for it. If the hon. Gentleman is arguing for more democratisation of the health authorities, that is a separate issue, and we should discuss it.

Simon Thomas: The logic of the hon. Gentleman's argument is that we would not vote on the issue in Committee. He said that he does not feel totally confident about the arguments. There must be a clear, accountable process by which to decide these matters, whether it is at local level in England, or Waleswide.
 The real question is how the public are to be properly informed about the subject. What sort of choices will they be given? For example, will they be given a choice between fluoridation and a community dental service, with the reintroduction of the school dentist going to every school and ensuring that children brush their teeth properly? One is just as effective as the other. 
 We are not arguing against the use of fluoride in the prevention of dental caries, but against the means of delivering it. We are arguing for the power of the individual to decide which means to use. The hon. Gentleman is on dangerous ground in suggesting that these things should be consulted on, when it should be a matter of individual choice. People should have that option.

Nick Palmer: The hon. Gentleman is being uncharacteristically frivolous to suggest that the Committee would not be entitled to vote today as a consequence of my argument. I am not saying that we should decide yes or no to fluoridation. What we are deciding today, and what will be decided on the Floor of the House, is who should decide, which seems an entirely appropriate thing for the Committee and the House of Commons to decide. In fact, I cannot see who else would do that, except perhaps the Welsh Assembly. Who decides is a political decision, but thereafter it should be primarily a health decision, and a health decision should properly be taken by a health authority, not a privatised water board.

Hugo Swire: The problem is that the health authorities will have to rely on the contrary medical evidence on which the Committee has relied. They will have views, of course, but they may not coincide with the views of the local electorate, who might be more convinced, for instance, by the fact that 98 per cent. of western Europe has rejected water fluoridation. The evidence of the York review was mentioned, but how independent was that? It was funded by the Department of Health to the tune of £80,000 a year. You have to think carefully before you say that a health authority will have a better insight than anyone else in the argument.

Nick Palmer: I note the hon. Gentleman's view that the Chairman needs to think carefully about that. I am sure that he will keep it in mind.
 The difference between a health authority and us is that it is a health authority's job to assess health issues. With all due respect, very few of us have enormous medical expertise. I am not an expert on dentistry or the effect of different chemicals in the bloodstream. I can take a serious amateur interest in that, as can the hon. Gentleman, but I do not believe, although I may be underestimating him, that there are many research chemists and doctors on the Committee—I know there is one. 
Several hon. Members rose—

Nick Palmer: I am anxious not to monopolise the discussion; I see that my hon. Friends are looking a little nervous. I have had three requests for interventions and I give way to the hon. Member for Leominster.

Bill Wiggin: I shall not delay the hon. Gentleman long. He is making the point that strategic health authorities know best, and although he may or may not be right, the real weakness in the argument is that they should not conduct the consultation process, because they come with an agenda. That is the real fear, but we shall deal with it later.

Nick Palmer: Yes. I have said that the serious point is how the consultation should be conducted and to what extent one should simply weigh and count the responses or consider the arguments. I agree that those are all serious issues, but we shall vote today on whether the decision should be taken by the strategic health authority or by the privatised water companies, and I just do not see the case for the latter.

Andy King: It is important to recognise that we are not considering this legislation such that the moment that it is passed every health authority will be expected to rush out and have referendums on the basis of where we are today. If the legislation is sound, it will be around for a long time, and I would expect and trust strategic health authorities to undertake the fullest possible consultation and to give a balanced view of the research available at the time. I certainly hope that more and better information will be available to health authorities when they consult communities.

Nick Palmer: I entirely accept my hon. Friend's point and I share his trust, but let me reflect on the points made by a number of Opposition Members. If there were an amendment to spell out in greater detail what steps needed to be taken for the consultation, I for one would feel that that would be quite helpful on Report. However, the principle is who should decide, and the principle of the Bill seems entirely right.
 Fluoridation is, by common consent, helpful to teeth. It does not appear that there is a danger from it. There is a reasonable case for asking people to accept health measures, if they do not impose a danger, in the national interest, or for placing a modest additional cost if they insist on evading such measures. The decision should be made by the strategic health authority.

Norman Baker: Let me come back to the question of who should decide. It is an important question. There is an argument that the individual should decide, not a Government body, health authority, water company or anybody else. It is a standard accepted philosophy that people have the right to decline medical treatment. The Minister will know that well from her portfolio.
 We are getting into some sophistry as to whether fluoride is a medicine. I am happy to accept that it is not defined as a medicine under the Medicines Act 1968, but that is not terribly relevant in a sense. What is relevant is that the argument for the addition of fluoride to water is that a health benefit will be derived, and that that benefit will be the improved condition of teeth, and so on. Government Members have referred to that. The driving force here is one of health, and that constitutes a medical benefit. The hon. Member for Broxtowe, who I assume will vote in favour of fluoride on Report, identified it as a medical benefit although not necessarily a medicine. That is sophistry; the issue is whether people should have forced on them a health benefit that they do not want. I do not think that they should, even for their own good. 
 As to who decides, the individual should decide. That choice is not in the Bill.

Siôn Simon: Just to explain that concept of ''force'', a tiny number of people have objections, apparently entirely unfounded, to the substance in question being in the water. If that tiny number of people choose to opt out of the water from their taps, how are they forced to drink it? We should let them get some other kind of water—for instance, bottled Hampshire water such as we have here.

Norman Baker: There are two points to that intervention. The first is whether one could entirely opt out, notwithstanding the comment about bottled water, because one goes through one's life drinking water in different establishments, in restaurants and in people's houses. One cannot simply opt out of water in that way.
 Secondly, the more interesting philosophical point is whether the majority in a population—if it is a majority in this case, which I expect it is—has the right to impose its view on the minority.

Nick Ainger: It is the other way round.

Norman Baker: No, it is not. If the majority wants to compel the minority to do something, does it have the right to do that? That is an important philosophical point. As Members of Parliament, we have to listen to majority views. We do so all the time, and would not be elected if we did not. However, we are also here to defend the minority, and those who do not want something. When we pass any sort of legislation, we always have to think what the consequences are for somebody who does not want it and whether it should be imposed on them against their will.

Richard Burden: I understand the hon. Gentleman's point, but I wonder how far he would take it. Where would he draw the dividing line between something added to water as a benefit, and something added to water to prevent what is perceived to be a danger? Somebody else might draw a different conclusion. If somebody had a deeply held, if illogical, personal conviction that chlorine in the water was dangerous and they wanted to opt out of it, would they have the individual right to do that?

Norman Baker: That is a fair question. These are difficult matters, and it is difficult to get absolute answers to them. We all have to draw lines where appropriate. There is a sensible line drawn there, between something that prevents a public health hazard, such as chlorine, and something that is not necessary to prevent a hazard but would be beneficial. There is a distinction, and it might be difficult to draw, but that is probably where I would draw the line.

Simon Thomas: These are valuable arguments that we should always have on legislation. It is important to think these things through. However, we should also look at whether we can achieve the same aims without legislation. In this case, we can clearly achieve similar aims. People cannot add chlorine to their water after it comes out of the tap to cleanse it of bacterial substances and so on, but people can add fluoride by choice to their diet or toothpaste, or however they wish. The science shows that that has much the same effect.
 It is not a question of a minority imposing its views on a majority, because everyone has a choice. There is an alternative, and we should think about alternatives before we legislate.

Norman Baker: We need to think about alternatives in any situation. I am instinctively more comfortable—as I imagine all Committee members are—with a situation in which we can choose to have something rather than having it forced on us. That is the natural position of any MP. However, there is a question about whether the alternatives provide the same benefits and reach the same target groups, and that calculation must be made.

Siôn Simon: Is not the hon. Gentleman in danger of following the hon. Members for Ceredigion and for Leominster in multiplying six counterfactuals by seven hypotheticals and ending up with a load of waffle?

Norman Baker: That comment was a load of waffle. In my inadequate way—we are all inadequate in our own ways—I am trying to reach a sensible outcome to a difficult moral question that has health implications. I do not pretend that that is easy.

Bill Wiggin: Will the hon. Gentleman give way?

Norman Baker: I will, but I am keen to make some progress.

Bill Wiggin: I am keen to help the hon. Gentleman make progress. The comment from the hon. Member for Birmingham, Erdington (Mr. Simon) was disingenuous, especially as he told the Committee a few minutes ago that if people did not want fluoride in their water they should buy bottled water. That is fine if people can afford it. It was an extraordinary comment from someone who is normally more rational.

Norman Baker: That is a point for the hon. Member for Birmingham, Erdington rather than me, but the hon. Member for Leominster has made his point.
 Who should decide whether to fluoridate? I have set out the philosophical difficulties that I have with the way in which the Government are moving forward, but we can be clear about who should not decide. The water companies should not decide. To that extent, I agree with the Government. It cannot be right in terms of democratic accountability to ask water companies to decide such matters. Nor is it fair on those companies to be put in the middle and to be asked to make decisions. They do not like it, and have made it perfectly clear that they are happy to be taken out of the equation. I hope that we are on common ground on that. 
 I am slightly alarmed by the Conservative suggestion that the water companies could decide, not least because dangerous ideas from the Conservative party tend to end up in Labour party manifestos five years later. I hope that that will not happen on this occasion. 
 There are complications about who should decide. Later, we will have a discussion about local authorities and health authorities, but I would like to place on the record my view that health authorities should not decide such matters. They are perceived as having an agenda—whether they do or not—and as being biased 
 and as looking after the health aspect. Health authorities are doing their duty and trying to further the health of the population, but they do not have an agenda for civil liberties, or for locality and accountability in the way that local councils do. If we are to have a decision-making process, people must feel it is fair and want to sign up to it. If they do not get the result that they want on what for some people are terribly important issues, they must at least feel that it has been a fair process. They will not feel that if health authorities are involved. 
 The other point is that health authorities are not local. The Minister keeps saying that they are, but they are not. Surrey and Sussex health authority represents my area, but it is not local at all. It is not even based in Sussex, so what can it know about what happens in Lewes? That is apart from the fact that it has only just been set up and has not yet got its feet under the table. A local decision is not the same as a sub-regional decision. 
 Whoever takes the decision—the health authority, the local council or whatever—there is still the complication of boundaries. Water supply boundaries are not the same as health authority boundaries, local council boundaries or any other boundaries. Whatever the body mentioned in the clause happens to be, we will be asked to take a decision that may cross over the boundaries of two water companies. I do not know how that will be dealt with. Perhaps the Minister will tell us when she responds. 
 The amendments in my name and that of my hon. Friend the Member for Guildford (Sue Doughty) and the hon. Member for Ceredigion seek to do two things. First, they suggest that the Secretary of State, as a matter of principle, should fund any consultation. I believe that that is right: this is a national issue, and the funding should come from the centre rather than from health authorities, councils or any other body. Hon. Members may disagree, but that is our position. 
 Secondly, and perhaps more important, amendment No. 158 suggests that the process of adding fluoride to water can be undertaken and concluded only if public opinion is ''clearly in favour'' of such an addition. That is not 90 per cent. in favour, by the way, but ''clearly in favour''. It is important that more than a bare majority are in favour for reasons of accountability, which I mentioned a minute ago, and for the acceptability of the result. The process must be seen to be fair, consultative and exhaustive. 
 Hon. Members mentioned referendums. I hope, by the way, that Hansard writes referendums, not referenda, when it reports my comments. As far as I can tell and unless I have misread it, the Bill contains no guarantee of a referendum, only regulations made by the Secretary of State. This consultation process, which would be conducted by health authorities if the Government had their way, could therefore simply be one of those farcical arrangements of the sort that we had when NHS trusts were set up, whereby the health authority calls a meeting in a draughty village hall on a Thursday evening, puts a notice in the local paper that 
 no one notices, three people come along to harangue the person holding the meeting, and the health authority declares that consultation has taken place. We must be given a much clearer explanation of what consultation means, and this should be given earlier, rather than later, in regulations. That is key.

Nick Palmer: Is the hon. Gentleman saying that we need referenda—or referendums, as the case may be—or is he merely saying that he would like a little clarity?

Norman Baker: I am saying that I do not want a facility in the Bill that could lead to the addition of fluoride to water. That is my view, not my party's, and I shall vote against such a provision on Report as a matter of individual liberty. Notwithstanding that—without prejudice, as it were—if the Government are going to go ahead with the proposal, it is very important that the consultation process is as I described. The hon. Gentleman also mentioned voting on consultation on Report. It is important that the Minister gives some indication of the form of that consultation.
 Lastly, this is an issue of individual liberty and it is of significant magnitude for some people. We should not underestimate how strongly some people feel, and that strength of feeling should be respected. Does adding fluoride to water cause harm? I suspect not, but the jury is still out. There is the issue of brittle bones, which hon. Members have mentioned. It is probably safe, but I am not 100 per cent. convinced, and the York review said that further research was necessary.

Simon Thomas: I believe that we agree on the York review, but it is worth making one point that has not been made so far, which is that adding fluoride to water may or may not cause harm, but there is an identifiable cosmetic effect. In America, for example, fluorosis is prevalent at about 12 or 15 per cent. That is predicted to be much the same as the levels at which the Government are considering introducing fluoride into the water supply. We are talking about harm to health, and the hon. Gentleman's comments were perfectly correct in that regard, but we should put on record that we at least acknowledge the cosmetic effect on teeth as well.

Norman Baker: I am happy to accept that in conjunction with the point that I made, which is no demonstrable harm is done. We know that, although the jury is still out and the York review says that further work is required. Equally important, however, there needs to be quantification of the benefits. If we are going to impose this on people, there will have to be very clear, undeniable and substantial health benefits. Those are the two tests that I have.
 I spoke to my hon. Friend the Member for Oxford, West and Abingdon (Dr. Harris), who was the Liberal Democrat spokesman on health until quite recently.

Robert Key: Totally unbiased then.

Norman Baker: I wanted some input on health issues; it is important that I understand the health benefits, so I had a long chat with him. If I may say so, he is very keen to believe men in white coats, and
 whatever doctors and scientists say. That is a matter of dispute between us on issues such as GM crops. I asked him what he thought of the matter. His view, as a doctor as well as our health spokesman, was that the benefits from fluoride are not necessarily substantial and certainly not proven to be so, although the benefits are there.
 The issue is whether what my hon. Friend regards as a marginal benefit justifies such action. We are asking the country to accept fluoridation—which many people object to on civil liberties grounds—for a questionable or marginal health benefit. I do not think that that is justified. 
 In conclusion, I cannot support the Government's wish—and it is a wish—to have fluoride added to water. However, if we are to go down that road—I come back to the amendments—it is important that the consultation process is open and exhaustive, seen to be unbiased and is held in such a way that people feel comfortable with it even if they do not like it.

David Drew: I shall try to keep my remarks to what has not been said rather than to what has been said. I start with the point on which the hon. Gentleman finished. I am somewhat confused and concerned as to the Government's position on fluoridation.
 With such a controversial issue—and it is controversial; there is substantially more opposition to fluoridation than some people would have us believe—it is only right for the Government to say exactly where they stand on the matter. Yet a clause was introduced in the House of Lords in a rather confusing debate. It was not clear whether that clause was Government-inspired or whether, as I had been led to believe, there was all-party support for the proposition that it was about time for the debate and for the legislation to be introduced. I cannot recall reading in any Labour manifesto—I admit that I do not carry one around with me—or in any Labour party policy document that the policy of fluoridation has been advocated. 
 I am sure that my hon. Friend the Member for Birmingham, Northfield will get the opportunity to speak at this or a later stage, He will say that fluoridation is extant in his area and has been for a considerable period. There is some agreement in the Committee that, although the medical case is not proven, fluoridation does considerable good. No one can, hand on heart, make the allegation that it does medical harm. However, that is not the issue. The issue is this: if the Government genuinely believe that fluoride is an important part of health policy, indeed public policy, they should be honest and open enough to say, ''That is what we believe in; that is what we are supporting.'' 
 I always welcome the freedom to vote as a matter of conscience. However, if the matter is such an important policy item, I would have expected the Government to say, ''This is what we are advocating and putting forward.'' Although the Minister has made a valiant attempt to provide a rationale, I am not convinced.

Siôn Simon: Surely the logic is exactly the same the other way round. One could say that in not making it
 compulsory, the Government see fluoridation as a positive thing, but not as something so definitively important that they will legislate so as to make it compulsory. They will leave it up to people.

David Drew: I am not sure whether that intervention was a help or a hindrance. We either legislate, or we do not. At the moment, it is left to the water companies to generate enthusiasm for putting fluoride in the water, which is unsatisfactory. However, there has not been much enthusiasm because, since the original fluoridation scheme of many decades ago, no water company has advocated it. In fact, I and my hon. Friend the Member for Birmingham, Northfield, have the same water company, and correspondence that we have received on the subject suggests that people do not want to go along that route. However, the Government seem to be sitting on the fence. They seem to be saying that even if fluoridation is wanted, and even if we can see a better way of doing it, and even if they concede the benefits to the public, they will get someone else to push it forward.

Robert Key: I have received perhaps 10 letters and e-mails on the subject. How many letters or e-mails has the hon. Gentleman received?

David Drew: Hundreds in opposition, but as the hon. Gentleman will know, things are somewhat different in Stroud.

Robert Key: Hundreds?

David Drew: Hundreds in opposition to it. Certainly, campaigns against it are now collecting signatures.
Dr. Iddon rose—

David Drew: I give way to my hon. Friend, who can give us some scientific advice.

Brian Iddon: I am sure that my hon. Friend must be aware of the recent NOP poll that showed that 67 per cent. of those who were polled were in favour and only 22 per cent. were against. That is one of several NOP/Gallup polls that have been taken across the country during the past 18 years that have shown a substantial majority in favour of the fluoridation of water.

David Drew: I am always willing to take advice from opinion polls when they tell us what we want to hear. I see no reason why people should not be informed on the matter. We should have an open, honest and meaningful debate on whether fluoridation is the way forward. However, I feel more passionate about the fact that what we are talking about will do little to advance dental health care. The only way to do that will be to rebuild the national health service dentistry service.
 As I said, it is most unfortunate that the body that we are asking to engage in so-called consultation and to make an appropriate decision is the strategic health authority. Indeed, I am annoyed, because it was only recently set up, and has no expertise or experience. I would not say that it has no interest in the subject, but it has no practical way of gauging people's opinions on it.

Andy King: Is it possible for the Minister to ask the strategic health authority to act as an honest broker, but to engage instead the primary care trusts? In my
 experience, they are champions acting on behalf of the health of my local communities. In their short life, they have already proved to be a good ally of the community.
 As for the opinion poll, it may have found that only 22 per cent. are against fluoride, but they are a strong minority who have given the subject much thought. The 67 per cent. who say that they are in favour have been brainwashed by years of fluoride toothpaste advertising, and being told that fluoride is a wonderful thing that can only do good.

David Drew: I thank my hon. Friend for being much more helpful than I expected when he started his intervention. I cannot comment on his second point, because I do not know what questions were asked. However, his first point, which was well made, was that there were other bodies that could better gauge the health of the community. The primary care trust has the authority to commission health policies for its local population. I shall not rehearse the argument, but being local means that the community has some recourse, and it can be done at a much lower level. Certainly, without organising a huge referendum, my strategic health authority of Avon, Gloucestershire and Wiltshire has no way of gauging whether people think that this is an appropriate way forward.
 How do we gauge the view of the health communities on that? What will the Government do in response? Is this the appropriate way to go forward? One of the points that have not been picked up at all is why the Government have tabled amendment No. 338, which replaces ''Secretary of State'' with ''appropriate authority''. This is about the process of consultation. I am not sure what it tells us. It seems that who will drive this forward will come out of the ether. It will not be the Secretary of State. The Secretary of State will still have the power to look at the regulations by which the process may be kicked off, but I am confused about where the Government come in. Will they drive their health policies forward or will be it some other agency? If so, which agency, and what powers will it have? 
 The health authorities, according to their representative bodies, have made up their minds about fluoridation. The British Medical Association has written to us all and told us that it is categorically in favour of fluoridation, apparently largely because of equity. It wants targeted help to be given where poor dental health is a problem. It argues that it can be targeted through fluoridating the water supply. The British Dental Association is even keener. Indeed, to go back to the point made by the hon. Member for Salisbury, to counteract those from the National Pure Water Association and anyone else who may have organised a campaign against fluoridation, the BDA is running a campaign in favour. 
 I receive many things through the post, but the two sets of dentures did not impress me. I should like to know how it can be proved that the state of the two children in the photographs is entirely the result of fluoridation of the water supply. Perhaps the people who sent them will write to me. The last time I made 
 comments about dentists I received quite a lot of correspondence, so I am wary. When I opened up my computer screen today I had a message from ''The Dentist''. Thankfully, it was a spam message, but I feared that they were looking at ways of dealing with me.

Robert Key: Did the hon. Gentleman, like me, chuckle at the fact that photographs of disfigured teeth were sent to us from both sides of the argument?

David Drew: I have had few cards on this and they were all from dentists or people who work for dentists. It seems that the profession has made up its mind and it will influence the strategic health authority. It will certainly influence other health bodies. I am saddened that we are dealing with the effect rather than the cause. We have to look at how we can rebuild NHS dentistry. It is sad that the organisation that represents dentists see this as a way in which we can deal with tooth decay. To me it is a sop. It would be much better if it encouraged its members to go back and treat NHS patients again.

Simon Thomas: I very much share the hon. Gentleman's view. I come from an area where 71 per cent of the population do not have an NHS dentist. Does he also share my concern that in a letter the Minister wrote to us arguing for fluoridation she says that it is cheaper than changing people's habits, costs around 50p per person per year, and that a year's supply of toothbrushes and toothpaste costs around £10? She suggests that we will go for fluoridation at 50p a year and give up a campaign to get people to brush their teeth with fluoride toothpaste. That spurious argument emphasises the hon. Gentleman's point.

David Drew: The hon. Gentleman has made his point, although I do not concur completely with it. There is no effective substitute for good dental health care. I worry about whether the measure will deal with a growing problem—many young people will not see a dentist and will be given no encouragement to go to a dentist. Fluoridation is not the answer to that.

Norman Baker: I should like to emphasise what the hon. Gentleman said. Do not many dental health problems arise from gum disease, which would not be helped by the measure? If people felt that they did not need to go to the dentist because their teeth were looked after, they might, as a consequence, end up with gum disease.

David Drew: I am sure that that is so.
 My philosophical objection to the provision is that it looks at the wrong issue and causes unnecessary controversy. The Government know that it is controversial, and they are effectively saying that it is up to somebody else to implement it, but they are providing the means whereby to do so. They know that the consultation process is meaningless. There is no way that consultation can be carried out through strategic health authorities. As if by magic, we will end up with fluoridation in many more areas. That is not honest politics and it is not the way to do it. Let us have a proper debate so that we can see whether there 
 is merit in fluoridation—but not as is suggested. I shall vote for amendment No. 301 and against the clause.

Robert Key: We have had a good debate this morning. I have been sipping the excellent mineral water provided by the House, which contains 0.2 mg of fluoride per litre at 8 to 12ºC.
 The amendment says that if a health authority wishes the water supply in its area to be fluoridated, there should be the widest possible consultation before a decision is made. That is the nub of the argument today. 
 I am impressed, and always have been in my political life, by arguments of individual liberty, freedom of choice and human rights, which are important in any mature western democracy. I also care about child health. This is one of the many times in the 20 years I have been in the House when a balance has to be struck. We had endless debates about water fluoridation some 20 years ago—when the House was similarly vexed about the issue—but it seems no more than five minutes ago. 
 Like other hon. Members, I have done my homework on fluoridation in recent weeks and months. I received a written answer from the Minister on 25 September. I asked 
''by what methods other than fluoridation of public water supplies safe levels of fluoride can be delivered to the population.''
 The Minister replied: 
''Trials are underway offering fluoridated milk in schools and, in some parts of Europe, fluoridated salt is on sale'',
 as we have discovered. She said that her Department 
''introduced the brushing for life scheme whereby free fluoridated toothpaste is given to families with young children in areas of high tooth decay'',
 but 
''Findings to date suggest that none of these measures yields benefits equivalent to those derived from water fluoridation.''—[Official Report, 6 October 2003; Vol. 410, c. 1288–1289W.]
 I have talked to dentists in Salisbury, including my own—but without my mouth full of cotton wool and steel. I have had a proper conversation about the issue. My dentist thinks that this is a very difficult matter because, speaking professionally, there is no doubt that fluoridation is a success. However, he feels strongly about individual liberty and freedom of choice. Only this morning, he said that he is glad that I am making the decision, not him. It is right that Parliament should make the decision, rather than the dentists, scientists, or anybody else. We have a difficult job to do. 
 I have also been approached by a consultant clinician at Salisbury district hospital, who had no doubt that as long as he and his colleagues in the hospital had to extract the teeth of children aged four under general anaesthetic, and there was an alternative to fluoridation, I should very strongly support the clause today. Let us be in no doubt that medical and dental opinion is divided. As I— 
 It being twenty-five minutes past Eleven o'clock, The Chairman adjourned the Committee without Question put, pursuant to the Standing Order. 
 Adjourned till this day at half-past Two o'clock.